1. How well are we addressing Asthma Disparities
How well are we addressing Asthma Disparities? Demonstration of a Self-Study Toolkit
Robin Shrestha-Kuwahara, MPH, Maureen Wilce, MS
Centers for Disease Control and Prevention
November 12, 2010
AEA, San Antonio, TX
National Center for Environmental Health
Air Pollution and Respiratory Health Branch

2. Session Objectives Session Objectives:
To present background on development of Asthma Disparities Self-study Toolkit
To share cultural competency assessment tool from Toolkit
To solicit your ideas on the tool, its usefulness, ways to improve it
Small group exercise – 20 minutes
Report back – 10 minutes

3. The Context One of overarching public health goals is to
eliminate health disparities
Disparities in prevalence, severity, morbidity, and mortality of asthma
Asthma disparities have multiple, complex, and interrelated sources
Inadequate access to care
Substandard quality of care

4. Asthma – Definition, Risk Factors
Asthma: chronic inflammatory disorder of the airways characterized by recurrent episodes of breathlessness and wheezing
Risk factors increased by:
Hereditary and environmental factors
Family history
Other genetic factors affect responsiveness to medications
Exposure to airborne allergens and other irritants trigger asthma attacks

5. Burden of Asthma
20 million people in the US currently diagnosed with asthma
12 million experienced an asthma episode in the previous year
Annually:
14 million office visits
2 million emergency room visits
Half a million hospitalizations
4,000 Americans die from asthma
$56 billion spent on asthma (‘07)

6. Asthma in U.S. Minorities
Current asthma prevalence among children
Black children slightly higher prevalence than white children, however . . .
Emergency department visits are ~3x higher among black children
Mortality rates ~4-5x higher
Puerto Rican children have highest rates of asthma (19%)
Asthma morbidity and mortality among adults
Prevalence higher among blacks than among whites, but
Mortality is 3x higher among blacks
Mortality rate of Puerto Ricans 3x that of non-Latino whites
American Indians and Alaska Natives higher prevalence than whites

7. CDC’s National Asthma Control Program
Created in 1999
Supports the goals and objectives of Healthy People for asthma
Based on the 3 public health principles:
Surveillance; Interventions; Partnerships
Program’s goals:
Reduce deaths, hospitalizations, emergency department visits
Reduce school /work days missed
Reduce limitations on activity due to asthma

8. Strategies to Reduce Asthma Disparities
Target many aspects of asthma care
Policies and regulations
Operation of the health care system
Barriers to care
Social/environmental factors
Provider-level factors, including communication skills and cultural competence training

9. Need for Cultural Competence
Importance of addressing disparities in health and health care is magnified by the rapidly changing demographics of the nation
“Cultural Competence” -- a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations (HRSA)
Being respectful of and responsive to diverse patients will facilitate positive health outcomes

10. Asthma Disparities Logic Model

11. Asthma Disparities Toolkit
– CDC developing Self-study Asthma Disparities Toolkit
Purpose: To guide asthma grantees and their partners in identifying, developing, implementing, and evaluating appropriate interventions to reduce relevant asthma disparities
Grounded in the Office of Minority Health’s Strategic Framework and CDC Evaluation Framework
5 units, planning and assessment tools, other resources
Integrates the 14 CLAS Standards

12. 14 Culturally and Linguistically Appropriate Service (CLAS) Standards
Office of Minority Health’s (OMH) approach to improving cultural and linguistic competency in health care
Standards 4, 5, 6, 7 are mandates for all recipients of federal funds
Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13 recommended for adoption as mandates
Standards 1-3
Culturally competent care
Standards 4-7
Language access services
Standards 8-14
Organizational supports for cultural competence

13. The Cultural Competency Assessment Tool for Asthma Programs
Purpose: to identify strengths and areas for improvement regarding cultural competency
Individual assessment process
Diverse staff reflective of communities served
Represent wide range of positions
Consensus process
Staff participate in collective assessment, prioritize areas for improvement, build consensus
Develop an action plan – implement and evaluate
Disseminate findings

14. Small Group Exercise – 20 minutes Report Back – 10 minutes
Have groups briefly review CC Assessment tool
Split groups into “direct service providers” and “state-level administrators”
From your group’s “perspective”, brainstorm how you expect each CLAS standard would be manifested
Record these indicators on the Worksheet
Representative of each group report back

15. Contact Us! Robin Shrestha-Kuwahara
CDC, National Center for Environmental Health
Air Pollution and Respiratory Health Branch –
Maureen Wilce –